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Data Collection Form
(To be filled only by physician)

A retrospective, cross-sectional, observational survey study to understand the role of Sodium Hyaluronate eye drops in management of dry eye disease

Patient {{$iPatientNo}}

  1. As per your clinical practice, which is the most common causes in patients diagnosed with Dry eye disease (DED), as observed in your practice? (Tick all applicable) *

  2. As per your clinical practice, kindly provide the approximate break-up of patients with Dry eye disease on the basis of dry eye disease type? *
    3. Aqueous tear deficiency
    %
    Blepharitis/Meibomian gland dysfunction
    %
    Goblet cell deficiency/Mucin deficiency
    %
    Exposure-related dysfunctional tear syndrome
    %
    Total 100%
  3. Kindly rank the most common co-morbidities observed in Dry eye disease patients as per your practice? (Please rank from rank 1 to rank 5 as from most common to least common comorbidity) *
    4. Glaucoma
    Post-operative
    Rheumatoid arthritis
    Diabetes
  4. As per your clinical practice, which are the most common symptoms in patients diagnosed with Dry eye disease (DED), as observed in your practice? (Please tick the applicable option) *

  5. How frequently are the patients with dry eye disease required to follow-up ? (Please tick the applicable options) *

  6. What is the approximate percentage of patients with dry eye disease requiring artificial tear formulations, as per your practice? *

  7. As per your clinical practice, kindly rank your preferred tear substitutes/ ocular lubricants in patients diagnosed with dry eye disease? (Kindly specify the rankings in front of each agent as per your preference) *

  8. As per your practice, what is the preferred treatment option for below mentioned patients with complaints of dry eye disease? (Please tick the applicable option for each of the conditions) *
    9. Cellulose based Dextran based Gelatin based Polyethylene glycol based Any other
    Post-LASIK

    Post-Cataract

    Post Photorefractive Keratectomy

  9. As per your practice, what is the appropriate reasons for prescribing Sodium hyaluronate eye drops treatment option in your patients for below mentioned patients with complaints of dry eye disease? (Please tick the applicable option for each of the conditions)*
    10. Better symptomatic relief Better improvement in clinical signs Improvement in vision quality Cost/ availability Any other
    Post-LASIK

    Post-Cataract

    Post Photorefractive Keratectomy

  10. What is the advantage of Sodium hyaluronate eye drops over other treatment options as per observations in your practice? *

  11. What is the average duration of therapy advised for Sodium hyaluronate eye drops as per your practice? *

  12. Any other medication which you use concomitantly with of Sodium hyaluronate eye drops in patients with dry eye disease? *